Is it acceptable to assign male technicians to assist in gynecologic surgery without obtaining consent from a female patient?

Gender Preference Disclosure and Consent in Gynecologic Surgery

Patients must be explicitly informed about the gender of all personnel who will be present during gynecologic surgery, and their consent must be obtained if staffing differs from their stated preferences. This is not optional—it is a fundamental requirement of patient autonomy and informed consent.

Pre-Operative Screening and Documentation

Incorporate gender preference questions into routine pre-procedure screening questionnaires using non-gendered, inclusive formats 1. This should occur during pre-operative assessment, allowing patients to privately and safely disclose their preferences 2.

• Ask sensitively in a private environment with clear explanation for why the question is relevant, which increases patient confidence and reduces feelings of discrimination 1.
• Document the preference clearly in the medical record where all team members can access it, avoiding repeated uncomfortable conversations 1.
• Share this information only with those for whom it is relevant and with patient consent 2, 1.

Explicit Disclosure Before Surgery

Before sedation or anesthesia, explicitly inform the patient of all personnel who will be present in the operating room, including their roles and genders 1. This is critical because:

• Women demonstrate strong same-sex preferences for intimate procedures, with 92.3% preferring same-sex providers for procedures like colonoscopy 1.
• History of abuse is a critical factor—both men and women with a history of physical or emotional abuse are significantly more likely to prefer female providers 1.
• Obtain explicit consent if the staffing differs from the patient's stated preference 1.

The Ethical and Legal Imperative

The landmark case Schloendorff v Society of New York Hospital underscores the constant need for improved communication among surgeons and the perils of implicit consent 3. Delegating the obtaining of consent and miscommunication among clinicians creates significant medical-legal risk 3.

• Medical student involvement in pelvic examinations under anesthesia (EUAs) is inconsistently disclosed to patients, causing significant distress to students and risking erosion of attitudes about patient autonomy 4.
• 67% of students reported they never or rarely witnessed explicit explanation that a medical student may perform a pelvic EUA, despite 84% of students performing at least one during their clerkship 4.
• Students face significant emotional distress when consent processes are at odds with their personal ethos and professional ethical norms 4.

Special Considerations for Transgender and Gender-Diverse Patients

Transgender and gender-diverse patients have low confidence that healthcare workers understand their needs and fear encountering prejudice and discrimination 1, 5. This makes provider gender preference even more salient.

• Use the patient's chosen name and pronouns throughout all interactions 2, 1.
• Pregnancy and gynecologic procedures can exacerbate gender dysphoria, anxiety, and depression in transgender and gender-diverse patients 2, 1, 5.
• Confirm preferred language and terms before discussing procedure-related information, as individuals may have different degrees of dysphoria around gendered language and anatomical names 5.
• Transgender status need only be shared with the patient's consent and if it is deemed important for the safety of their care 2.

Clinical Outcomes Impact

Respecting preferences reduces anxiety and embarrassment, which are primary barriers to seeking care for intimate health concerns 1. Creating an open and inclusive environment during surgical procedures is important, as undergoing surgery is a vulnerable time for any patient 1.

• Female physicians conduct longer visits, use more patient-centered approaches, and are more likely to discuss emotional issues and actively seek patient input 1.
• Patients of female providers report higher satisfaction with their interactions 1.
• When transgender persons receive medically appropriate, affirming care, they experience improved mental health, reduction in suicide rates, and lower overall healthcare costs 1.

Common Pitfalls to Avoid

• Do not assume implicit consent based on admission to a teaching hospital—patient awareness and understanding vary significantly 6.
• Do not omit asking simply because accommodating the preference may be difficult—documenting the preference allows for future accommodation and demonstrates respect for patient autonomy 1.
• Do not "out" transgender patients by calling them by birth names in waiting areas or other public spaces 1.
• Do not assume absence of gender preference based on patient demographics—approximately 46-57% of patients express no gender preference, but those who do have strong preferences that must be respected 1.